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Behind the ABA Talk Podcast
Join host Lisa Gurdin, founder of LSGurdin Consulting, for heart-to-heart conversations with expert speakers from the LSGurdin Consulting Continuing Education program
Behind the ABA Talk Podcast
Behind the ABA Talk Ep. 8 - Pediatric Anxiety Disorders: What Behavior Analysts Need to Know with Dr. Hanna Rue
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In this episode, we dive into the world of pediatric anxiety with Dr. Hanna Rue. As a clinical psychologist, behavior analyst and leader in the field of ABA, Dr. Rue shares her take on how behavior analysts, clinicians, educators, and parents can transform the lives of children grappling with anxiety. This conversation is packed with valuable tools and perspectives to help you support your favorite young people along their journey toward emotional resilience.
Links to Hanna's On-Demand CEU events:
Pediatric Anxiety: What Every Behavior Analyst Should Know
Enhancing Supervisory Skills: A Supervision Panel for BCBAs
Connect with Hanna via LinkedIn
Follow, Connect, Reach Out:
https://www.linkedin.com/in/jennifer-r-9a327434/
www.linkedin.com/in/lsgurdinconsulting
Welcome to Behind the ABA Talk Podcast, where we have heart-to-heart conversations with ABA experts, thought leaders, and change makers. Each episode unpacks the stories, insights, and behind-the-scenes realities that shaped our experts' professional journeys. I'm your host, Lisa Gerden, founder of Ellis Grid and Consulting. In today's episode, we've dive into the world of pediatric anxiety with Dr. Hannah Roo. As a clinical psychologist, behavior analyst, and leader in the field of ABA, Dr. Roo shares her take on how behavior analysts, clinicians, educators, and parents can transform the lives of children grappling with anxiety. This conversation is packed with valuable tools and perspectives to help you support your favorite young people along their journey toward emotional resilience. Hi Hannah, thank you so much for being here. Yeah, we have known each other for several years now, both as practicum supervisors as part of Northeastern University's Master's in ABA program. And that's been so fun talking and sharing how to do all the supervision and challenges, the ups and downs of it all.
SPEAKER_01Yes.
SPEAKER_00Definitely the ups and downs. And you have been so kind to do two continuing education presentations. One is part of a supervision panel, enhancing supervisory skills, a supervision panel for BCBAs that is in the on-demand library. We presented all together in Portugal at the International Applied Behavior Analysis Conference. And that was so much fun to have us together in Lisbon and then have an audience full of people from all over the world doing behavior analysis, you know, in all these different contexts. It was so cool, I thought.
SPEAKER_01Oh, it was, yeah, it's one of those moments where you're pretty proud of what you do in the field that you're in. Um to have an international audience and to have folks from the US with us over there. Um, I don't know, there's a special type of camaraderie, I think, um, that happens at those conferences, but the um the conversations are the same in terms of being um interesting and valuable, just the the context is uh more exotic, if you will, than being in a conference center somewhere in the US.
SPEAKER_00Yes, but I what I found so fascinating was like we're all behavior analysts, we're all the trained trained in the same way, yet we live, you know, across the world from one another, and we are having those same conversations. Right. Right? But that's so it may look a little different and have you know, but um, but it was really cool. I I loved that. Um, and then you also did a um a presentation on pediatric anxiety when every behavior analyst should know. And both those events are on demand right now, and at the end of the episode, I'll share a special discount for both CE events for those of you behavior analysts who would like to um earn CEUs, and those who are just interested to hear more of what Hannah has to say. Um, so to start, Hannah, can you share your journey in ABA and talk about your clinical psychology, experience, and training and ABA and how the two kind of, you know, mesh together for you?
SPEAKER_01Um, I think at some point my story kind of converges with a lot of folks when you come into the, you know, I sit mostly now in the world of autism and developmental disabilities. But when I started, I worked in an operant lab at McNey State University with uh Dr. Cameron Melville. And so I was still uh wondering if I should go back, I was going back and forth between more clinical work, being a counselor, psychologist, um, and then you know, stumbled upon this uh laboratory where they were doing um animal models of human behavior, specifically sensitization and habituation. Um, and I became extraordinarily interested in that. And so spent about three years of my life uh with 150 or so uh very large uh sprig dolly rats, I think they were. Uh so we did my master's thesis was on the habituation theory of multiple scheduled behavioral contrast, and I was really loving the EAB world and uh was very excited to dig into more uh more learning phenomenon and things like that. We we looked at things like um addiction, alcohol addiction, cocaine. We looked at um even eating disorders within that laboratory. So it was phenomenal. Uh this is where my story kind of converges with others, though. It was back in the 90s, and a family had called the department to see if there was any uh graduate students who might be interested in working with their young child with autism. And my professor had said it would probably be a good idea to get some applied experience, even though I planned on at that point pursuing EAB for my uh for my graduate school career. And I went in uh to this family's home and they had a three-year-old, and he was just um as cute as could be. But what was fascinating to me, uh, all of the things that I saw us doing in the laboratory applied to this little guy, and uh that really stuck with me. So I continued uh, you know, doing some work. That's when I worked on the front lines, you know, 30 hours a week as a behavior tech and took a few years off to do some consulting and uh moved to North Dakota. Uh at that point I was working for the state of North Dakota as a behavior analyst or a behavior psychologist. I forget what they called us. There weren't any behavior analysts at that time because there was no board. Uh, this is before the BACB, uh back in the dark ages. And uh so I was consulting with, I worked with the state of North Dakota and the state of Minnesota overseeing group homes for adults who were duly diagnosed with mental health issues and with developmental disabilities. So still working with some adults with autism, but across the gamut, uh, you know, just about everything that uh you can imagine within that, within that world. At that point, I decided it'd probably be a good idea for me to get a clinical psych degree so that I could expand my uh breadth of knowledge and then also participate in the diagnostics. So that's what I did. I went straight for a uh very traditional clinical psych degree at the University of North Dakota. That program is uh fantastic. It sets you up to be licensed, you know, anywhere in the country. They set you up really nicely to be prepared for um APA pre-doctoral internships. So I finished my PhD there and I matched on match day with May Institute just outside of Boston, and that's when the focus really uh honed in on autism applied behavior analysis, uh, working under Dr. Jim Lewiselli for a number of years. Uh from there, then after about 10 years at May Institute, I ended up at Learn, where I'm the chief clinical officer, and I make use of both my applied behavior analytic uh degree as well as my clinical psych degree. I'm sure we can talk a little bit more about that. So it's a little bit of a winding road, uh, but my heart is always within behavior analysis.
SPEAKER_00So when you when you think of that and your you know varied experience, um, how do how did you integrate kind of that clinical psychology lens with the behavioral lens? Because there's overlap, yet there's different ways to um conceptualize um and describe behavioral phenomena, really.
SPEAKER_01Yeah, what's interesting and what I appreciate about my clinical psych background is uh the different theories of personality and behavior. Um, and so having an understanding of you know those other schools of psychology, I think only enrich my behavioral perspective so that I could translate, if you will, it's almost like um speaking two languages, you can translate uh just about everything through a behavior analytic lens. And so just taking into account uh the environmental context, you know, I find extraordinarily important, obviously, um, as a behavior analyst. Um, and so with that, um, you know, and obviously, you know, physiology plays some part in it too. And so we know, you know, mental health, just like anything else, is going to be a combination of your environment, your genetics, um, your learning history, and things of that nature. Uh so I can understand, you know, some of the you know overt behaviors that we see and measure, as well as uh, you know, some of the things that people talk about within the skin, if you will, those private events. And so, for example, I've worked with folks who have um, you know, more like an obsessive-compulsive disorder, and they're talking about uh intrusive thoughts that they have. And so that's where I think some of my clinical psychology training comes in. Uh, I don't shy away from talking about those things, but I can understand their impact as well as provide appropriate treatment, taking into account, you know, that behavior analytic component, you know, looking at the environment and how that environment, how the individual's environment may impact, you know, what they're experiencing privately.
SPEAKER_00Yes, absolutely. And so that brings us really to, you know, your your focus on pediatric anxiety and really integrating those two approaches. Um, and I I love that because it really adds so much richness to our understanding of our kiddos. And it just seems like everyone is walking around with a level of anxiety that we've never seen. There are way more kids who are diagnosed with anxiety and other complex disorders when at younger ages, and it's manifesting in all kinds of challenges. Um what do you think is happening right now, like from your perspective?
SPEAKER_01Um, that's a complex uh question with a probably even more complex answer, right? I think there's a lot happening in where I sit, you know, we serve mostly individuals with autism, but what we're seeing more of um are children coming in with um additional diagnoses of ADHD, anxiety, and depression. And I think probably just like with autism, we're getting more awareness around anxiety and diagnosing it better. Um pediatricians are probably um more aware of you know of those types of mental health disorders now and uh providing appropriate referrals. You know, everyone's probably seen on social media and within the news that we're in a mental health crisis nowadays. Uh there's probably some impact of social media, right? Um, you know, and the pressures on young folks these days are different, you know, than what we experience, than what I experienced whenever I was young. And so I can't imagine having access to information 24-7, um, constant contact and things of that nature. So I do think uh there's a component there. Um, you know, I also think there's a a lot going on in the world too. Um, and when you think about stressed adults, right? Yes. Um, in a household with children, um, that certainly has to have an impact as well. So I think there's a number of environmental factors, uh, but we're maybe as a society, as professionals, getting better at identifying those things and diagnosing those things now, just like we're better at identifying autism and diagnosing that.
SPEAKER_00Yes, I agree. And it feels like there's a little bit more of a willingness to go to that mental health diagnosis than there was before, where there's such a stigma, right, for for decades about that mental health diagnosis, and no one wanted to acknowledge it. And it seems like people are shifting into the space of, okay, here we are, here's what we got. Now what do we do about it? Um, and behavior analysts have traditionally, you know, shied away from those mental health diagnoses, right? And you talked about how your clinical psychology training allows you to move toward it, right? To say, to embrace it and say, okay, here we go. This is what we have, this is how it, you know, it's working. Um for those behavior analysts who are who are out there listening, um, how what are the paradigms that we can use to help us, you know, understand anxiety and and develop more skills and confidence to say, okay, I I got this. We're gonna we're gonna deal with this.
SPEAKER_01Well, really, behavior analysts have everything that they need in terms of understanding, right? This is the overt behavior. And a lot of times it's around a learning history of avoidance, right? Uh so they you contact some aversive stimuli, situation, person, whatever it might be, and uh there's a response. And then if it's repeated or if it's just that one trial learning, sometimes once is enough, and you're like, ah, I'm gonna avoid this as much as I possibly can. And that's again a relatively simplistic perspective of it. Uh, but it really um I think kind of captures it. Uh what you hear from individuals who are experiencing anxiety is they're oftentimes trying to avoid or getting uh try to get away from something, right? So if we can imagine what that is in a complex environment, it might not be so easy to suss out exactly what that is or or what anxiety looks like when you're first getting to know an individual, right? Because you can have um avoidance that's um that's manifested, you know, vocal verbally, like I don't want to, that's not okay. You can have someone pull away, um, you can have someone just not respond, right? And so avoidance behavior, as good behavior analysts know, comes in many forms and fashions. Um and so when do we come to the idea that it's you know anxiety? I think that's a little bit of a more complex kind of uh question too. And that's when you start to collaborate with other professionals, right? So that maybe it's not um, you know, if you if you're finding that what uh your work with this individual is not producing the results that you would expect, you're not getting as far along as you would expect, um, you know, and it's more um you're seeing it in, you know, kind of generalized across environments, right? The avoidance behavior is happening across multiple environments with multiple folks. Um, you probably want to, you know, bring someone else in. Uh, but it it really is uh it's about avoidance and escape and aversiveness that just make you uncomfortable.
SPEAKER_00Yeah, and I think there's that, you know, avoidance and escape from those external events that make you uncomfortable, but also internally. So, right, so if you're right, if you're having you know a big dramatic, you know, meltdown and you're getting a lot of attention and avoidance and escape, and there's a whole thing now you can ignore kind of that that feeling. Um, and I don't think that we necessarily at this point, any of us really, or a lot of us, you know, struggle with the the you know tolerance for that, right? And kids don't they don't know what that is, it's scary, it's you know, and so I think that's a big part of it too. It's that inter internal space that's uncomfortable. And we as behavior analysts can't see that. So, I mean, I think we have to look at those, you know, overt anchors, those behaviors you can see to indicate what might be going on internally, as well as that verbal behavior, that verbal report, that self-report that people can say when they can. And you know, you work you work with non-verbal individuals who so who cannot say that. So we need right to be very in both those private events and the behaviors we can see.
SPEAKER_01And that's what you know I love about clinical psychology. Whenever I work with um young folks experiencing anxiety, one of the first steps that we take in treatment is what we call psychoeducation, right? And it addresses those internal experiences. Um, and a lot of times that's what what you were just saying. Um, some kids are responding to that too, like my tummy hurts, um my head is hurting, my I'm getting dizzy, I feel my heart beat, you know, really fast. It's hard to swallow. So it's all of these physical manifestations. We might not be able to see that, like what you were talking about. So one of the first steps that we take is yeah, you're probably experiencing this. And let me give you some labels for that so that you can now start telling people, you know, this is this is what I'm feeling. Um, and for a lot of kids, um, that's really helpful. And so there's a number of books that you can find on Amazon or in bookstores that talk about in very simple plain language those experiences, right? Um, and sometimes just telling kids that this is normal, this is your heartbeat fast because you're because you're scared or you're worried or something like that. Um, sometimes that can help um an incredible amount uh just so kids know that it's normal, right? Um and it's not, you know, their body's about to explode. Uh so I've even seen the the initial psychoeducational step uh have impact on on kids because you're right, those private events can be um can be really upsetting.
SPEAKER_00Yes, yes. Um, and it's also the psychoeducation for adults to say, yeah, this is happening, it's okay, right? We all experience anxiety and kind of normalizing it for the adults in their lives as well, and to have some, you know, some compassion for like that and understand like that's what may be happening right now, and that doesn't feel very good. And we've all been there.
SPEAKER_01And yeah, we right, we've all been there. At some point in your life, you're going to have that anxious response where you have, you know, the increase in heart rate and you get a little sweaty and whatnot. Um, but I think you're right too. Um, especially, you know, we've had generations in the past who weren't so open about talking about these things. So I think about maybe now a day is maybe some grandparents and things like that. Um, and educating family members around that. Like when, you know, when you see the little one or the individual in your life who's, you know, kind of getting quiet, maybe putting their head down or whatnot, those can be indicators of anxiety and maybe they just hadn't recognized it, right? And so someone's not talking or not responding in a way that they should be, given the context or the social environment. Um, sometimes those that psychoeducation can also help family members understand that someone's in distress.
SPEAKER_00Yes, yes. And similarly, I think it's important to educate teachers and school teams as well who may not have that level of understanding. Um, and um, and especially I think in behavioral um uh more agencies and and behavioral programs that are really strongly rooted in ABA. Sometimes that's that approach isn't or that level of understanding, the private events isn't quite talked about as much as it should. And so I think we all kind of need to level up a little bit and kind of like go there. Like, let's all go there. Um, and I don't know for me, you know, collaboration has been the heart of how I've learned so much about anxiety and how I've learned how to address it and support people with anxiety. Can you talk a little bit about that that collaborative piece in your work?
SPEAKER_01Uh that's what I get really excited about, um, especially uh when I was working with a few anxious adolescents at um at May Institute. Um, it was an opportunity to teach about uh how to generalize some of these skills and work on things. And so just like you collaborate with a speech language pathologist, with um uh with the medical professional regarding you know medication or something of that nature, a psychologist can provide some of the same support. But what's really cool is if you're working with a behaviorally oriented psychologist and they're doing cognitive behavior therapy, CBT, the B is behavior, and most of the times the B is applied behavior analysis. And so you can take that piece of it and work with the clinical psychologist to participate in exercises, you know, help um, you know, diaphragm diaphragmatic breathing exercises. Um you can work on um, you know, using the uh subjective units of distress suds scales, you know. Um so one, I'm feeling really calm, ten, I'm you know. Really, really anxious and nature, things of those nature. You can also work with the clinical psychologist to help you know identify those ABCs, right? So as clinical psychologists, we're oftentimes kind of trapped, if you will, in our office setting doing 50-minute sessions. And if I have a behavior analyst come in and you know, show me some graphs or show me some ABC data about where an individual is experiencing some of these distressing experiences, it's really very helpful for me in our treatment path. And so I can collaborate with that person about what tools to use, practice with them in the, you know, within the office setting or even remotely. So there's lots of opportunities for collaboration and learning on both sides, right? That's what I really enjoy, and I've really enjoyed working with uh behavior analysts in that context to work on um pediatric anxiety.
SPEAKER_00Yes, absolutely. And I think it's so important that all of us as professionals are curious, right? We go into those collaborative meetings ready to ask questions. Oh, tell me more about that, right? Um I remember early in my career when I was working with social workers and in the school context, I remember going into their offices and sitting, sitting down and saying, okay, I don't understand what you're talking about when you talk about CBT or this or that or the other. Tell me. Like tell me about it, tell me why, tell me how it works, and tell me how I can support you, you know. And that's how I learned by just asking, tell me, you know, saying, tell me more and and why. And I want to learn. Um, and that I mean, has been so valuable.
SPEAKER_01It it's incredible. And that's that's really the scholarly part of you know our science, right? Is that we should always be clinically curious um throughout our journey. Um, and regardless of the field, anything, you know, behavior encompasses just about everything. And so there's so much to learn. Um the learning never ends. And so that's what um that's what I've always appreciated. And then also, you know, that individual. And so if you have a client, you know, and again, I've been on both sides of it. So if you're a behavior analyst working closely with a family in home or with this client, you probably know that person better than I doing doing 50-minute sessions, right? So I've got a lot to learn from you just from your experience with that client and with that family. So let me learn about what is that context really? What are you seeing there? Yes. So it can really make a rich um for a richer, you know, um uh treatment collaboration for that individual.
SPEAKER_00Yes, absolutely. And I I mean I've worked with clinicians who have, you know, taken, I say, okay, you take that. You know, I that's that I I can't really touch that piece of it. So you take that, I'll take this, I'll support, you know, parents and understanding that and you know, in the context of parent coaching and how to follow up, right? And I love that, right? And then and it's and that's just such a rich experience. I really enjoy that. And I always tell, I'm sure you do also talk to our students, you know, our graduate students about collaboration. I feel like, you know, I'm always talking about it and hey, have you had a chance to, you know, here's where you would want to connect with so-and-so, and you got to start your career, I think, with that perspective, with that openness.
SPEAKER_01There's something to be said about being humble, right? So a humble behavior analyst, but that can be applied to every a humble psychologist, a humble, you know, medical practitioner and the uh physician, if you will. Um, and so I do talk about that a lot. I think, you know, way back in the day, there were some behavior analysts who thought, you know, we could do it all. Yes. Um, and maybe that, you know, helped to develop um a not so great um relationship with folks that were out there. I remember again back in the 90s, you know, having a hard time explaining to folks and then also having some folks in my life who were um pretty adamant that we could fix just about everything and we didn't need anyone else. Uh, when in fact that is absolutely not true. Um, you know, even within behavior analysis, you know, they're applied behavior analysis, they're the specialties. And so there are folks, um, for example, who are trained, um very well trained in acceptance and commitment therapy, ACT, right? Act. Um, and so, you know, just because we have that within our field doesn't mean that everyone should be, can be doing that, you know, without the appropriate training and supervision or whatnot. Uh so if you don't have that training and supervision, even collaborating and learning within our field about that, you know, specific area, as well as outside of the field from a psychologist or a social worker, pediatrician, uh, it is all about collaboration because there is evidence-based interventions in each one of those helping professions.
SPEAKER_00Yes. And I think when you are talking with a professional trained in a different discipline, um we all of us in you know, in behavior analysis and other disciplines who are differently trained. I think there's that translation process, right, that we can do in our heads of like, okay, that's they're talking about, okay, I can explain that with respondent and operant conditioning. Okay, I can use relational frame theory, right? Oh, I think, you know, and kind of translating that in your head so you can understand it in the way you were trained, but you're really talking about the same, the same thing when it comes down to it. The challenges, this, you know, the supports that need to be um implemented for that individual to be successful in their life in their life.
SPEAKER_01Yeah, a lot of it is semantics. It's pretty funny, just like you know, you you walk into an SLP's office and you're doing the exact same thing and calling it two different things, um, and it really is semantics. And who the heck knows what what a tact or a man, you know, we have some pretty things in our in our world too, right? So, you know, requesting and naming and things of that nature. Um, yeah, there's something to be said speaking a common language, just understanding it from you know, from a behavioral perspective.
SPEAKER_00Yes, I remember in graduate school reading a study, um, or it wasn't really a study, it was it was an article about why um why behavior analysts should study emotion. And it was it's an old article at this point, I'm sure you know it. And I was enthralled because in graduate school, I was also in, you know, in the late 90s as well, and no one was talking about that. And I was like, there's gotta be more, and there's gotta be a place for it. And they just say, Yeah, we all need to have this common language, we all need to use the term anxiety. That's how we can start having these conversations. And yes, behavior analysts should learn about emotion, should look at it, should talk about it. And I was like, Yes, and we're getting there. It's taking some decades, but we yeah, slowly but surely we are getting there.
SPEAKER_01Yeah, no, I've seen it's uh tremendous what's happened in the past you know 30 years, right?
SPEAKER_00It's fascinating, it's a it's definitely an evolution and an evolution we can learn from as we move forward.
SPEAKER_01Yeah.
SPEAKER_00Um so you know, let's move on for from the sort of understanding and the paradigms for a moment, collaboration, talk about strategies, right? Because when it comes down to it, we really want to help people learn how to manage anxiety. We can't we can't delete it forever, you know, we can't get rid of it. Anxiety is part of life, it helps us survive, it helps us do well. Um, and so we all have to learn to live with a certain level of anxiety, tolerate the discomfort and all that. What have you found to be, you know, just uh you know, some of the best strategies that you found to support really the people that you've worked with, those people diagnosed with multiple um uh diagnoses, autism and anxiety, autism, anxiety and ADHD, you know, all of those. And and we're seeing, I don't, I'm I'm sure in your career too, you're seeing way more people with complex diagnoses. It's it's with multiple diagnoses. It's not a one-stop kind of a diagnosis situation anymore.
SPEAKER_01Yeah, no, that's what um, yeah, I I think I'm seeing it more and more now than ever before. Uh, the school age individuals coming in with autism and you know, uh a co-occurring anxiety disorder. Um, in terms of, you know, the evidence-based interventions, starting out really simply, you know, when you're collaborating with uh if you're looking at pediatric anxiety, collaborating with your social worker, a counselor, or um clinical psychologist, that psychoeducation piece, like I said, really important. Um, I've used a number of different books that I've you know taken from Amazon. Um psychoeducation doesn't happen just in that one, you know, 50-minute session. Um, kids need to get this information, you know, from different from different people at different places at different times, right? Because they have to be reminded, reassured, we have to ensure that you know they can talk fluently about their heartbeat, about their stomach or whatnot. Um, and I see a lot of kids check in, yeah, my heart, you know, is beating fast. Right, remember we talked about that. And so that psychoeducation piece is something that we can all do. Um, the one thing that I say is make sure that we're all using the same language, right? And so if you talk about your heart racing, right, it's different than your heart beating. So, you know, again, make sure that the language your your tummy feels weird or your stomach feels nauseous, you know, however you want to do it, make sure that those labels make sense to that young person. And that's the that's the language that the family's going to use. So I would continue with that psychoeducation until you know the labels are there, they can, you know, fluently talk about what they're experiencing inside and kind of use some of that language. You know, and then in terms of actual tools, like I said, the um the identification using the uh some sort of units of distress, like I said, um, is a really nice way to communicate that very simply. So if you need to engage in a certain practice or maybe even remove yourself from a situation, um having a thermometer or what have I used, or I think some sort of bathtub with the water filled up or something. Um, you know, the scale can be whatever that the child wants it to be. And so usually collaborating again with your with the counselor, you know, what is this going to look like? Practicing that again, it takes a little while to become fluent on what those things mean. And again, it's subjective. So you want some practice around, you know, what's this child look like at a one versus you know, another child at a one versus a five versus a 10? Um so you have to get to understand that and define it, and it doesn't happen in a in one clinic, you know, in one setting. Um, you refine that over time. Um, and then what are the, you know, what are the antecedent interventions, for example? Like how do you prime someone? You know, again, what's the language that you want to use? How far in advance do we talk about these things? That's important because anxiety happens when that trigger is coming up. Do I talk about, you know, we're leaving for the trip in in three days or do I talk about it within 24 hours, right? Um, so knowing about when to implement antecedent interventions and again the language to use, and then the consequence strategies too, right? Like when do we leave a context, right? When do we, you know, call in for supports and just you know, um, when do we need to get out of there? Uh other things I like talking about um are diaphragmatic breathing. So I've seen in a million different behavior intervention plans, you know, let's breathe, let's take a breathing break. And then I just watch a kid sit there go, and I'm like, you know, and then breathing, yes. Yeah, the breathing. I'm like, um, it doesn't, you know, it doesn't necessarily work for everyone. And and first you have to do it with fidelity. You've got to do it correctly, right? And so I'm really big on talking about what that is, belly breathing, and how to practice it. You can't you have to first learn to do it correctly to be able to use it.
SPEAKER_00Yeah.
SPEAKER_01And so you can't tell a kid to breathe and expect, you know, expect, you know, them to experience calm or or or or whatnot. So I think sometimes that's something that gets a little confused out there in a in the behavior analytic world.
SPEAKER_00And it's the same for adults. Like we all we have apps that tell us to breathe for God's sake. Like, you know, we we have to breathe and do all those things so we can stay calm and then we model that and we talk about it, right? And I think that's something, you know, there's there's a lot of universal universality to what we're talking about here. Okay for all humans. Like this is not a kid problem, right? This is a right, right. All of us need to work on those skills.
SPEAKER_01Well, and you'll see me sometimes, you know, depending on the context or you know, where I'm going or whatnot. Um, I still use the I went through a systematic desensitization. I used to have uh extraordinary fear of flying. Absolutely.
SPEAKER_00Oh my gosh, that would not be good with your current job. And I when I see Hannah, I say, where in the world is Hannah Rue?
SPEAKER_01Yeah, you know, I'm traveling about a hundred days out of a year. I'd, you know, take probably a hundred flights or whatever. And so it used to be debilitating. And so it actually, my it was actually Dr. Cam Melville who said, okay, well, let's do systematic desensitization. So before I even went into clinical psychology, you know, and I went through and I did a hierarchy or whatnot, and that's when I learned about, you know, appropriate diaphragmatic breathing. And so I still use that. And obviously, you know, flying now has become a lot easier, but every once in a while, you know, you hit a few bumps, and I'm just like, and instead of bracing up, you know, I put my hand on my chest and a hand on my belly, and then I sit there and I have to think about it, right? Um, to engage those muscles, to engage, you know, the full breathing exercise. And so I still use it. Um, and it's been very effective. But again, it's a skill that you've got to develop in practice and ensure that you're yes, and that practice.
SPEAKER_00And I found also kind of visuals to cue kids can be helpful, especially if they don't have the language to process um that verbal language, you know, visuals I found to be very helpful. Also, I found to be very helpful not talking very much as adults, like keeping that, you know, the verbals down, because if you're anxious and stressed, you cannot process language. And so everyone just needs to like shh, you know, bring it down. Um and adults have to practice that. And I keep going back to that because kids can't learn if adults around them don't do it and show them and support them. So it's a big part of the puzzle.
SPEAKER_01Yeah, and it's really scary to watch a kid have a panic attack. It's really scary to watch anyone have a panic attack, but when you watch a child have a true panic attack, it's very, very scary. And so you do have to learn to remain calm and to understand it's just a panic attack. They are, you know, hyperventilating, they're frozen oftentimes, they're crying, they're really distressed. And like you said, to remain calm, and a lot of times, and what I've done, you know, is to try and get some sort of like focus, right? Like, look at me, look at my eyes, just try to get their attention and some repeated phrases, right? And again, these are things that you talk about beforehand. Right. We're experiencing the attack. I'm probably going to hold your hands and I'm going to say, look at me. Yes. Look at me, you know, those sorts of things. And then with some individuals, you know, I'll say, we'll start talking about breathing and we'll wait for a moment. But again, it's kind of learning that pace with that individual child when they're in that crisis situation, um, and talking about, you know, previously what will happen when these very distressing situations happen. But you're right. Yeah. You've got to remain calm in a very distressing situation.
SPEAKER_00Yes.
SPEAKER_01Um, and you've got to remain quiet most of the time, which is hard for some people.
SPEAKER_00So hard because we tend to go the we tend to keep talking. Um, you know, so I I work with staff a lot on that. Like you want to keep talking. You have to do the opposite. And so replace it with some breathing, right? And and having your own mantra, right, during that time. And learn to kind of, I learned I had a child who had panic attacks during a period of time. Um, and I had to learn to ride the wave, to not control it, not trying to stop it, but to ride that wave. And I had to learn and I had to practice. Um, and it took a minute, but we did it, and the panic attacks went away. And now I know what to do in those situations. But I called my psychologist friend and said, Hey, I have no idea what to do. Um what tell me. And she said you have to ride the wave, and she told me exactly, you know, what you described and and what I need to do. And and then I was like, I had a plan. Right. It's a beginning. Yeah. I was like, okay, I may call you again because I don't exactly know how this is gonna play out, right? Um, we may need some support, but I have a plan now, and and it worked. And um it's uh we have it so much to learn from one another. And when I think about you know, young behavior analysts or new behavior analysts in the field, aspiring behavior analysts, our our students that we have, Hannah, what would you, what advice would you give them, you know, um, after decades in the field, and when they do have that first client, that second client, whatever, who is diagnosed, you know, with anxiety, um, what advice would would you give them? And I guess would that be, you know, maybe that's the same advice you'd give to your younger behavior analyst self, you know, about it.
SPEAKER_01Yeah, well, my younger behavior analyst self would be um you don't know everything. You need other people. But you know, when I'm talking to, when I'm talking to our graduate students, um you know, recognizing that it's okay to ask for help and that it's okay to not know. So one of the things that I have at Learn Behavioral is a peer review system. Um, and so actually we we changed it to a uh clinical skill building grounds and we've kind of rebranded so that the focus is we're helping you build skills, we're building our skills, you're building your skills, and that's what it's all about. In the beginning, you're not gonna know everything, you're just starting out, right? Um every client is different, presents differently. Um, anxiety, if you will, manifests or looks different. Um, and so it's okay to reach out, to find supervision, um, to ask questions, like you said, always be clinically curious. Um and and to uh collaborate, right? Um that's where you're gonna learn a lot, like what you were saying, you know, talking to social workers, talking with psychologists. Um I've learned so much from the collaborations over decades. Um, but I think some people um have that feeling that they should, that they should know more.
SPEAKER_00Yes, right.
SPEAKER_01I think there's a lot of expectation on folks, and folks hold themselves um to a standard. Uh and you don't have to. There's there's a bunch of us, like you and I, are always available to our students, supervisors or should be available, you know, to the younger, newer behavior analysts. Yes. Um so it's okay to reach out and it's okay to um ask for help. Um and if you you know, if you recognize that something is outside of your scope to speak up, you know, ethically, we're we're obligated ethically to to speak up and to refer clients to you know, folks who might have experience with, you know, whatever it might be, if you can't access that supervision that you need in order to appropriately treat.
SPEAKER_00Um I think we need to be comfortable and practice being in that space of I don't know and I'm gonna find out versus I don't know and I'm not gonna deal with it.
SPEAKER_01Right.
SPEAKER_00And those are two different things. And so ethically, we need to look at those barriers, right, to progress and barriers to inter implementing interventions, and we need to deal with them. And so that means asking for help. That means saying, I'm not quite sure. I see this problem, I understand it this way, I'm not quite sure what to do about it. We need some people to help us, right? And that's this that's the skill set I think that we all need to always work on and like it's okay. And tell ourselves that's okay. Like That's how we're going to do it.
SPEAKER_01Oh, absolutely. Right. You know, if if you're within your first year out, there is no expectation. If you came from a, you know, early intervention place, you know, with like little two and three-year-old toddlers, that's a whole different thing than, you know, first or second grade in a school environment, as you know, right? It it's different. And so asking for help is the appropriate thing to do and recognizing, you know, when it's outside of your scope, it it's always okay. And if someone tells you it isn't, then that person probably isn't practicing ethically. Sometimes that does happen too.
SPEAKER_00Right. And it's not only your first few years out, it's always. I mean, I'm calling people, I'm, you know, we've had conversations of like, do you I know all the whole task list, Lisa? You know, I have to ask Hannah, and you're like, no, I look stuff up. I I model how to find it, right? And say, I don't know, right? And so we can't know everything. It's and we just have to be humble and and ask those questions, find those people who know more of the answers, and go there because we it will be a very um enlightening and fulfilling experience to to go there.
SPEAKER_01Yeah. I and you know, with the skill building rounds that we do, you know, we say it could be anything. It can be, you know, I'm not sure how to program for the next step. I'm not sure how to explain this to the family. You know, the response, you know, the client's response doesn't isn't they aren't responding in the way that I thought they should. It could be, you know, any one of those things. It doesn't matter. Um we welcome that. Um again, it's about it's about being a scholar, it's about engaging in scholarship and learning. Yes. Um that's that's how we should live our lives. Because yeah, I I learn every single day too.
SPEAKER_00Right, right. I mean, I mean, that's the whole sort of, you know, my why for the Continue Education Program. And my why, you know, for the podcast is talking about these things that are hard, you know, and sharing what we've learned, um, and sharing our vulnerabilities. Yeah, like we don't know everything. Um, and so um that's yeah, for me what it's all about too. And I am just so thrilled that you spent this time with me, Hannah. It's always nice to to connect with you and to um to talk about these really important things. So thank you so much for being here.
SPEAKER_01Well, Lisa, you know how much I appreciate your dissemination of information and your support of behavior analysts, you know, um, around you and you know that that you're able to to touch outside of, you know, even New England or whatnot. Um, so I appreciate that. I think you're one of you're one of those uh leaders that um truly believes in dissemination and you know supporting others. And so um I'm always happy to join you uh and be a part of your world.
SPEAKER_00Thank you, Hannah. Thank you. Um well this has been Behind the ABA Talk Podcast. I'm Lisa Gerdon, and we have had our amazing guest, Dr. Hannah Roo, here, who um is at Learn Behavioral Leader in the field, um, traveling all over the world talking about behavior analysis and how to practice um ethically and how to experience joy while doing that. So I appreciate all that you do and thank you so much for sharing your journey and your recommendations for deepening our understanding of anxiety, of our of our young people, the people we support and their families, so we can help our clients, our families, the individuals we support, the individuals in our life experience really more meaning and joy because I think that's what it's all about. Um so be sure to click the link in the podcast episode description to listen to Dr. Rue's On-Demand CE in the Alice Grinning Consulting Continue Education program, hosted uh by Behavior Live. And um, her CE is Pediatric Anxiety, what every behavior analyst should know. Um Hannah Rue is also uh one of the panelists on enhancing supervisory skills, a supervision panel for BCBAs where behavior analysts can earn um CEUs, um supervision CEUs. And then um the promo code is H R Podcast, H-R-P-O-D-C-A-S-T, for 50% off of both CEU events. Um, so I hope you go to the events and hear more from Hannah. Um, and thank you again for being here, and a special thank you to my podcast producer, Cole Asher Hoffman, and we will see you next time.